Verletzungen der Fußwurzel

Abstract

Injuries of the midfoot comprise fractures, dislocations and/or fracture dislocations of the Chopart and Lisfranc joint lines. Fracture dislocations, in particular, represent prognostically severe lesions which may compromise foot function to a substantial degree. A number of injuries of the midfoot (up to one quarter) are still primarily overlooked. As such, a diagnostic algorithm is essential for the adequate detection of the injury components and planning of the therapeutic approach. Standard x-rays in three planes (dorso-plantar, lateral and lateral oblique views) represent the diagnostic basis which is supplemented by CAT scanning and multiplanar reconstruction, especially in cases where a potential midfoot lesion is suspected. MRI may be helpful in mainly ligamentous injuries only. Latent instability may be revealed by dynamic assessment employing stress fluoroscopy. Chronic instability may be detected by weight-bearing radiographs displaying manifest displacement and malalignment under load. The principal strategy of treatment includes anatomical reconstruction of the joint structures, the geometric proportions of the medial, central and lateral foot columns and the diagnostics and treatment of ligamentous instabilities.

Chopart- und Lisfranc-Luxationsverletzungen – operative Zugangswege, Lagerungstechniken sowie intraoperative Erfolgskontrolle

“…Betroffen sind die Articulatio tarsi transversa (Chopart-Gelenk: vorderes unteres Sprunggelenk) und Articulationes tarsometatarsales (Lisfranc-Gelenk). Die bekannten französischen Erstbeschreiber beschäftigten sich weniger mit Traumafolgen als mit präformierten Amputationsoptionen am Fuß [1,2]. Osteoligamentäre Kombinationsverletzungen liegen häufiger als isolierte Frakturen der beteiligten Fußwurzelknochen vor [2 -6, 8, 15].…”